Long-term respiratory outcomes following successful decannulation after tracheostomy: association of patient-reported dyspnea with spirometric findings and CT-defined tracheal stenosis

Persistent respiratory symptoms following successful decannulation after tracheostomy remain insufficiently characterized, and the relationship between patient-reported dyspnea, pulmonary function, and structural airway abnormalities has not been well defined. This study investigated the association between dyspnea severity, spirometric findings, and computed tomography (CT)-defined tracheal stenosis during long-term follow-up after tracheostomy and compared respiratory outcomes between open surgical tracheostomy (OST) and percutaneous dilatational tracheostomy (PDT). This prospective, single-center observational cohort study included 156 adult patients evaluated 12–84 months after successful decannulation. Dyspnea severity was assessed using the modified Medical Research Council (mMRC) scale. All participants underwent spirometry and neck and chest CT. Patients were classified according to previous tracheostomy technique (OST, n = 76; PDT, n = 80). Associations between mMRC scores, spirometric findings, and CT-defined tracheal stenosis were evaluated using Spearman’s rank correlation and ordinal logistic regression. Most patients reported minimal dyspnea (mMRC grade 0), observed in 56.6% of the OST group and 43.7% of the PDT group. Spirometric abnormalities were identified in both groups without significant differences in overall spirometric distribution. CT-defined tracheal stenosis was present in 27.6% of OST patients and 25.0% of PDT patients with mild stenosis, whereas moderate and severe stenosis occurred exclusively in the PDT group (5.0% each; p = 0.014). Higher mMRC scores correlated significantly with worsening spirometric category (Spearman’s ρ = 0.343, p < 0.001) and increasing CT-defined tracheal stenosis grade (ρ = 0.461, p < 0.001), whereas no significant correlation was observed with the FEV₁/FVC ratio. In multivariable ordinal logistic regression, both spirometric category (OR 1.49, 95% CI 1.17–1.89; p = 0.001) and CT-defined tracheal stenosis (OR 4.26, 95% CI 2.53–7.18; p < 0.001) remained independently associated with greater dyspnea severity. In patients evaluated after successful decannulation, patient-reported dyspnea was significantly associated with both spirometric abnormalities and CT-defined tracheal stenosis during long-term follow-up. Moderate and severe tracheal stenosis occurred only after percutaneous dilatational tracheostomy. These findings support the use of symptom assessment as part of a comprehensive evaluation of post-tracheostomy respiratory outcomes while emphasizing that the observed associations are exploratory and should not be interpreted as evidence of diagnostic or screening utility. Larger prospective multicenter studies are required to confirm these findings. ISRCTN24668317 (registered April 23, 2019; IRB No. YSMU 7/18–19).